Provider Demographics
NPI:1770798100
Name:MATHIS, LARK ANN (MSW)
Entity type:Individual
Prefix:
First Name:LARK
Middle Name:ANN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LARK
Other - Middle Name:MATHIS
Other - Last Name:DEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:POBOX 300044
Mailing Address - Street 2:C/O GREG JOSS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2622
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical